Povidone-Iodine Induced Skin Burn: Case Report and Literature Review

Pei-Chin Lin1,2, Pi-Lai Tseng1,Yaw-Bin Huang3

1 Department of Pharmacy, Veterans General Hospital in Kaohsiung, Kaohsiung, Taiwan2 Graduate Institute of Pharmaceutical Sciences, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan

3 Graduate Institute of Clinical Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan

Abstract code: TOX-W-017Session: Toxicology and Safety Sciences

3rd Pharmaceutical Sciences World Congress in Amsterdan, the Netherlands. 22-25 April 2007

Background Background

Case ReportCase Report

Discussion Discussion

Conclusion Conclusion

Povidone (Polyvinylpyrrolidone)-iodine has been used widely as a topical antiseptics for would cleaning or operation site disinfection from 1956. The preparations of commercially available povidone-iodine (PI) are PI solution, scrub, ointment, tincture or foam; of these, the solution is the most commonly used. Iodine is complexed with povidone in this water-soluble compound. The antiseptic action of PI is due to the available iodine present in the complex and generally has a favorable adverse-effect profile. However, PI has been rarely associated with chemical burn. In this study, we report 2 cases who developed skin burn and blister formation after using of povidone-iodine tincture.

Case 1 is a 34years old female who was admitted to receive Electrophysiologic study(EPS). Case 2 is a 74years old male and Implantable Cardioverter Defibrillator (ICD) Implantation was suggested due to the positive result of EPS. At the first of procedure, after application of the topical 10% PI tincture (70% alcohol) over the operation site, both of them felt some liquid flowed beneath the thigh or flowed to the left upper back through the neck individually. Then, in the case 1, patient felt irritation and pain beneath the thigh; in case 2, the same sensation was described in the area of lower back and left upper back. The sensation of irritation and pain persisted till procedure ended. Burned skin and desquamation were observed several days later in case 1. The patient did no receive any treatment and the affected area healed automatically. In the other one, erythematous change happened immediately after the procedure and then 3 x 3 cm2 area of burn was measured 5 hrs later after the patients was sent to the intensive care unit. 10 x 10 cm2 area of burn with several blisters formation were seen in the day after procedure (Fig 1). Betamethasone cream was topically applied and acetaminophen 500mg every six hours were used to relief the pain. The blisters were exposed by nurses 4days

Given the widespread use of povidone-iodine and the potential for development of infection after a burn, the most important factor for preventing the adverse drug reaction is the awareness of the clinicians and the preventive measures.

Review of the literature, burns can be rare but potentially serious complications of PI use. There are some case reports about this adverse reaction in the literature. Figure 2 show the characteristics of cases of PI-associated burns. In these patients, PI (solution or tincture) was in contact with the skin for at least 1 to 8 hours or longer. The area of burn usually seen under a gauze swab soaked in PI antiseptic solution, in contact with a surgical sheet immersed with PI, or under a tourniquet cuff where the PI had been absorbed by the padding. The clinical presentation of the affected skin is burn with/without vesciles or blister. The onset of symptom noted is the day or the next day after procedure.

Fig 2 The description of povidone-iodine-associated burns

Fig 1 Case 2. Burn after prolonged contact with PI tincture

This adverse reaction of PI application typically occurs when it has not been allowed to dry or has been trapped under the body of a patient in a pooled dependent position. The probable mechanism is a chemical burn due to irritation coupled with maceration, friction, and pressure. The epidermal lipid barrier acting to the skin may be decreased by another washing using alcohol, which deesterifies the skin. Alcohol may also cause hypersensitivity. Reviewing the cases in our study, these 2 patients were all macerated in the pool of PI tincture, and in case 2, the clinical appearances resembled chemical burns, showing clearly marginated infiltrative erythema accompanied by blister. The adverse reaction induced by PI could not e excluded. Fortunately, both of them were resolved automatically or under he conservative treatment.

nurses four days later

and no secondary

infection observed.

There was no abnormal

in the operation site but

burn only developed in

the area that contact

with the sheet. Besides,

there were no PI allergy

history in these 2 cases.

Age: < 2 – 79 yrs

Solution: 10% PI solution or in alcohol (70%)

Procedure and area of burns: Cardioangiography or other CV procedures: back or beneath thigh Gynecologic or neurologic operations: buttocksOrthopedic operations: the extremities where a tournique placed

Onset: immediate after procedure or next day

Duration of contact on skin: 1-> 8hrs

Clinical presentation: burn, with/without vesicles or blister